Metformin and SGLT2 Inhibitor combo helps attain HbA1c of <8% in most Diabetics

Complex pathophysiology and multiple physiological factors play a key role in the onset and the progression of Diabetes Mellitus. Combination therapy rather than monotherapy plays a major role in the management of the disease (1). Out of these Metformin, a biguanide is the first line of treatment for type 2 diabetes mellitus. Another novel class of oral anti diabetic agents are Sodium glucose cotransporter 2 inhibitors (SGLT2i). Metformin and SGLT2 Inhibitor Dual Therapy in attaining the HbA1c threshold of <8% was done in the United States, states a study.

Published in the journal of Diabetes in June 2020,by Dominik Lautsch et al, the study aimed to determine factors associated with attaining the HbA1c threshold of <8% in the United States. The study was Observational, retrospective cohort study in adult type 2 diabetes mellitus patients. Data was collected from IQVIA EMR database. Observation period was June 2015 to June 2018. For this Patients needed to initiate SGLT2i and metformin without other antihyperglycemic agents. The impact of sociodemographic factors on achievement of HbA1c <8% was tested using multivariable logistic regression with backward stepwise selection using SAS 9.4.

From the study the authors found that

• Out of 3491 patients in the final cohort, 2176 (62.3%) achieved HbA1c <8%.

• The remaining patients had a median distance to goal of 1.1% (IQR 0.5-2.3%)

• Mean age of the patients was 56.5 year

• Out of them 52.6% were male and 47.4% were females.

• In total there were 74.5% whites, 2% Asians, 13.7% Blacks, 8.5% were unknown

• Of the total patients 13% were smokers and 8.3% with established chronic kidney or cardiovascular disease.

• Black patients had lower odds to attain HbA1c <8% than white patients [OR 0.69 (0.57, 0.85)]

• While patients <65 years of age had non relevant higher odds [OR 1.01 (1.01, 1.02)]

From this study the authors concluded that in the real world in the U.S., 62% of patients treated with metformin and SGLT2i had an HbA1c <8%. Black patients had lower odds to attain this threshold.

The authors said that this study was funded by Merck & Co., Inc.

(1) Kalra S, Kesavadev J, Chadha M, Kumar GV. Sodium-glucose Cotransporter-2 Inhibitors in Combination with Other Glucose-lowering Agents for the Treatment of Type 2 Diabetes Mellitus. Indian J Endocrinol Metab. 2018;22(6):827-836.